Provider Demographics
NPI:1073784112
Name:JAMES E PARKER
Entity Type:Organization
Organization Name:JAMES E PARKER
Other - Org Name:HEALTH CARE SUPPLIES AND EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-346-5556
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-0938
Mailing Address - Country:US
Mailing Address - Phone:573-346-5556
Mailing Address - Fax:573-346-5788
Practice Address - Street 1:206 S MILL ST
Practice Address - Street 2:
Practice Address - City:ELDON
Practice Address - State:MO
Practice Address - Zip Code:65026-1864
Practice Address - Country:US
Practice Address - Phone:573-392-9956
Practice Address - Fax:573-392-9958
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES E PARKER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-17
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12145840332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO621781020Medicaid
MO621781020Medicaid